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SANiJ0AQUIN Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <br />If yes, location and distance: <br />CONAPI INI(, <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted <br />❑ Yes ❑ No <br />❑ Yes IJN0 <br />If yes, spoils storage Location: <br />Covered: ❑ Yes No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: N-5/tom <br />Grout Material: �-j C—C-- <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation f Boring Destruction <br />METHOD USED <br />❑P.ressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Monitorin <br />Well/Soil Boring Inspection Report <br />Date: 5 'Z. Inspector: <br />CONSTRUCTION <br />Facility Address: S <br />_ <br />. <br />#Bags <br />Well Address: �_ -) l yp-, <br />5 <br />1 <br />Total Depth: <br />WP# �{'L?,�1 <br />Well#: N)I f1 <br />Drilling Rig Type: <br />Soil Boring#: A .Q�, — <br />cs,�r� <br />5 <br />Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Drilling Company: ��[�( <br />_� <br />15 <br />3 <br />Driller Onsite: <br />30 <br />Screen Length From: To: <br />Consultant: C3.. Gid CroN <br />4 <br />20 <br />Filter Pack From: To: <br />Geologist: 5 P�C, <br />12.5 <br />25 <br />Bentonite From: To: <br />25 <br />50 <br />5 <br />Grout From: To: <br />Public Water System Onsite: <br />1:1 Yes <br />4 <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: <br />❑ Yes <br />/No <br />. <br />If yes, location and distance: <br />CONAPI INI(, <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted <br />❑ Yes ❑ No <br />❑ Yes IJN0 <br />If yes, spoils storage Location: <br />Covered: ❑ Yes No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: N-5/tom <br />Grout Material: �-j C—C-- <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation f Boring Destruction <br />METHOD USED <br />❑P.ressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />Rall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />10 <br />20 <br />4 <br />20 <br />0 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />ft <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />'Mentgnitp Rer 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />